In the early morning of August 3rd, surgeons at the University of California, San Diego Medical Center removed 80 percent of Connie Harris' stomach -- through her mouth.
It may sound like a form of medieval torture, but this method -- Harris is the first person to undergo the procedure -- is a new way to potentially diminish the pain and risk associated with gastric sleeve weight loss surgery.
"The goal was to have a less painful recovery and less trauma to the abdomen," said Dr. Santiago Horgan, chief of minimally invasive surgery at UCSD Medical Center, who performed the surgery on Harris.
Through-the-throat removal of Harris' excess stomach allowed Horgan to avoid cutting through her abdominal muscles, he said, because he did not have to make an incision large enough to accommodate the removal of the stomach.
Harris, 60, of Carlsbad, Cal., was expecting her fourth grandchild just two weeks after her surgery date and opted for this novel approach with hopes of a speedier post-op recovery .
Now two weeks into her recovery, Harris said, "It's been a good recovery so far. I was off pain medication within a couple days of the surgery. I'm going to the park with my grandkids this morning."
Horgan's procedure isn't such a far cry from standard laparoscopic gastric sleeve surgery. It only modifies how the excess stomach is removed from the body. This small change, however, offers an even less invasive approach that doctors say brings bariatric surgery one step closer to an incision-free weight loss surgery.
Towards Incision-Free Weight Loss Surgery
Horgan's procedure combines two well-established technologies -- gastric sleeve surgery and natural orifice surgery -- in a new way.
The vast majority of gastric sleeve surgery today is performed laparoscopically, via a series of small incisions in the abdomen. Tools, including a camera, are inserted through the incisions, and the stomach is stapled shut, reducing it to about one fifth of its original size.
Springing a Stomach Leak?
The excess stomach must then be removed by widening one of these incisions to accommodate it, said Dr. Scott Belsley, director of robotic surgery at St. Luke's Roosevelt Hospital.
This larger incision puts patients at a slightly increased risk of hernia and wound infection and can cause more pain during recovery, noted Dr. Cori McBride, director of bariatric surgery at the University of Nebraska Medical Center.
Using an endoscope with a snare, Horgan instead removed Harris' stomach through the esophagus and out through her mouth.
This approach, called natural orifice surgery, has been used in the past on other organs, or through other orifices, such as the vagina or anus, but to the best of Hogan's knowledge, this combination of gastric surgery and oral removal had not been tried.
"It's a clever idea and a clever application of the natural orifice surgery, one that moves us closer to developing a truly incision-less operation for weight loss," said Belsley.
The procedure is so new however, that potential risks of this approach have yet to be identified, McBride and Belsley noted, so it's unlikely that bariatric surgeons will immediately start using this technique.
For instance, there is risk that the newly stapled stomach will spring a leak, McBride said. This is a risk with gastric sleeve surgery in general, but there is a chance that pulling the excess stomach through the newer stomach en route to the esophagus could increase that risk, and content from within the stomach could seep into the abdominal cavity.
Horgan said that so far, this does not appear to be a problem and said he has another through-the-throat gastric sleeve surgery scheduled in the near future.
The Only Thing That Has Worked
Harris has been on a diet to lose weight since she was seven-years-old -- a battle she said she has been perpetually losing her entire life.
"I spent so long feeling self-conscious about my weight. Now that I'm 60, it's about health too," she said.
After seeing the health complications other overweight members of her family have suffered, Harris decided on a more permanent solution. She was 5'4" and nearly 200 pounds at the time.
"I have three grandchildren and two more on the way. I want to enjoy them and participate with them, not just observe. I want to enjoy whatever years I have left," she said.
Dr. Horgan has performed gastric sleeve surgery using the vagina as a natural orifice of exit and he has removed other organs, such as the appendix, through using the through-the-throat technique. Because of his experience, Harris said she felt very comfortable agreeing to the first-time application of the oral removal of excess stomach.
Now two weeks out from her procedure, she has lost a total of twenty pounds, some of which was lost during the specialized pre-operative diet she began two weeks before her surgery.
She will slowly reintroduce solid food into her diet and will be able to eat anything within five weeks.
"I know it's not the be-all, end-all solution. It's a tool and I still have to make the right [diet and exercise] decisions. My only regret is that I wish I could have done this ten or twenty years ago," she said.